What is the recommended prescription cream for a patient with dermatitis, considering their age, medical history, and potential allergies or sensitivities?

Prescription Cream for Dermatitis

For adults with dermatitis (atopic dermatitis/eczema), topical corticosteroids are the first-line prescription treatment, with medium-potency steroids like triamcinolone or mometasone for body areas and low-potency hydrocortisone 1-2.5% for face and neck. 1, 2

Treatment Algorithm by Disease Severity and Location

First-Line: Topical Corticosteroids

Topical corticosteroids remain the mainstay of active dermatitis treatment with high certainty evidence supporting their use. 1, 2

• For facial and neck dermatitis: Use mild-potency corticosteroids (hydrocortisone 1-2.5%) once daily 2
• For body/trunk dermatitis: Use medium-potency corticosteroids (e.g., triamcinolone 0.1%, mometasone furoate) once to twice daily 1, 2
• For severe, refractory cases: Very high-potency corticosteroids (clobetasol propionate 0.05%) may be used for short courses only 2
• Duration: Continue until clear or almost clear, typically 2-6 weeks 2

Steroid-Sparing Alternatives: Topical Calcineurin Inhibitors

When corticosteroids are contraindicated or for sensitive areas prone to atrophy, tacrolimus and pimecrolimus are strongly recommended alternatives with high certainty evidence. 1

• Tacrolimus 0.1% ointment: Strongly recommended for adults with atopic dermatitis, particularly effective for facial eczema and sensitive areas 1, 2
• Pimecrolimus 1% cream: Strongly recommended for mild-to-moderate atopic dermatitis in adults 1
• FDA indication: Both are approved as second-line therapy for patients who have failed other topical treatments or when those treatments are not advisable 3

Important caveat: The FDA black box warning regarding cancer risk should be discussed with patients, though long-term safety studies suggest the absolute risk of lymphoma is low and likely not clinically meaningful 1

Newer Non-Steroidal Options

For patients seeking alternatives to both corticosteroids and calcineurin inhibitors:

• Ruxolitinib cream (JAK inhibitor): Strongly recommended with moderate certainty evidence for mild-to-moderate atopic dermatitis 1, 2
• Crisaborole ointment (PDE-4 inhibitor): Strongly recommended with high certainty evidence for mild-to-moderate atopic dermatitis 1, 2

Both provide anti-inflammatory effects without the atrophy risks of corticosteroids 2

Maintenance Therapy to Prevent Flares

Once acute dermatitis is controlled, intermittent proactive therapy prevents relapses with strong evidence. 1, 2

• Apply medium-potency topical corticosteroids twice weekly (e.g., weekend therapy) to previously affected areas even when skin appears clear 1, 2
• This maintenance approach significantly reduces disease flares and relapse 1

Essential Adjunctive Therapy: Emollients

All patients with dermatitis must use emollients as foundational therapy regardless of prescription treatment chosen. 1, 2

• Apply liberally and frequently (at least twice daily) with recommended usage of 200-400 grams per week 2
• Most effective when applied immediately after bathing 2
• Choose cream or ointment formulations over alcohol-containing lotions 2

Special Considerations

Elderly Patients with Pruritic Dermatitis

• Initially receive emollients and topical steroids for at least 2 weeks to exclude asteatotic eczema 1
• Moisturizers with high lipid content are preferred 1
• Avoid sedative antihistamines in elderly patients 1

Contact Dermatitis

• Topical corticosteroids combined with soap substitutes and emollients are the accepted treatment 1
• Long-term intermittent use of mometasone furoate has demonstrated efficacy in chronic hand eczema 1

Common Pitfalls to Avoid

• Do not use topical antihistamines for atopic dermatitis—they are conditionally recommended against 1
• Do not use topical antiseptics routinely (conditionally recommended against), except bleach baths may be considered for moderate-to-severe AD with clinical signs of secondary bacterial infection 1
• Do not use topical antimicrobials routinely for atopic dermatitis 1
• Avoid prolonged continuous use of high-potency corticosteroids due to atrophy risk; use intermittent maintenance therapy instead 1, 2